Positive CT Research Articles

Effectiveness of Chest CT in Children: CT Findings in Relation to the Clinical Question.

To estimate the effectiveness and efficiency of chest CT in children based on the suspected diagnosis in relation to the number of positive, negative, and inconclusive CT results. In this monocentric retrospective study at a university hospital with a division of pediatric radiology, 2019 chest CT examinations (973 patients; median age: 10.5 years; range: 2 days to 17.9 years) were analyzed with regards to clinical data, including the referring department, primary questions or suspected diagnosis, and CT findings. It was identified if the clinical question was answered, whether the suspected diagnosis was confirmed or ruled out, and if additional findings (clinically significant or minor) were detected. The largest clinical subgroup was the hematooncological subgroup (n = 987), with frequent questions for inflammation/pneumonia (66 % in this subgroup). Overall, CT provided conclusive results in 97.6 % of all scans. In 1380scans (70 %), the suspected diagnosis was confirmed. In 406/2019 cases (20 %), the CT scan was negative also in terms of an additional finding. In 8 of 9 clinical categories, the proportion of positive results was over 50 %. There were predominantly negative results (110/179; 61 %) in pre-stem cell transplant evaluation. In the subgroup of trauma management, 81/144exams (57 %) showed positive results, including combined injuries (n = 23). 222/396 (56 %) of all additional findings were estimated to be clinically significant. In a specialized center, the effectiveness of pediatric chest CT was excellent when counting the conclusive results. However, to improve efficiency, the clinical evaluation before imaging appears crucial to prevent unnecessary CT examinations. · Pediatric chest CT in specialized centers has a high diagnostic value.. · CT identifies relevant changes besides the working hypothesis in clinically complex situations.. · Pre-CT clinical evaluation is crucial, especially in the context of suspected pneumonia.. · Esser M, Tsiflikas I, Kraus MS et al. Effectiveness of Chest CT in Children: CT Findings in Relation to the Clinical Question. Fortschr Röntgenstr 2022; 194: 281 - 290.

SARS‐CoV‐2 rapid antigen test in comparison to RT‐PCR targeting different genes: A real‐life evaluation among unselected patients in a regional hospital of Italy

We assessed the performance of the Panbio rapid antigen detection (RAD) test for the detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and we compared it with the routine reverse transcriptase‐polymerase chain reaction (RT‐PCR)‐based molecular test in a population of 4167 unselected patients admitted to IRCCS Sacro Cuore Don Calabria Hospital. Analysis stratified by cycling threshold (C t) value of SARS‐CoV‐2 gene targets indicated that antigen (Ag)‐positive C t values were significantly lower compared to Ag‐negative values (p < 0.0001). Overall, we found discordance in 140, tested negative by RAD and positive by RT‐PCR, and in 4 resulted positive by RAD and negative by RT‐PCR. RAD test achieved a sensitivity and specificity of 66.82% and 99.89%, respectively. The positive predictive value was shown to be 97.87% while the negative predictive value was shown to be 97.62%. In our context, the RAD test showed a reliable diagnostic response in subjects that displayed high C t values, corresponding to high viral load, while low ability was displayed to identify positive cases with medium‐low C t values, thus presenting low viral load and where confirmatory RT‐PCR was needed. Our finding supports the use of the RAD test in real‐life settings where a high volume of swabs is being processed but with caution when interpreting a positive test result in a low prevalence setting.

322 Clinical Factors Predictive of Both Successful and Unsuccessful Arterial Embolization in The Management of Lower Gastrointestinal Bleeding

Abstract Aim To develop a model of clinical factors that may predict: (1) technically and clinically successful embolization of a bleeding vessel at Digital Subtraction Angiography (DSA) for lower gastrointestinal bleed (LGIB); (2) a negative DSA in the presence of positive CT-mesenteric angiography (CTMA) for LGIB. Method A retrospective cohort study of all DSAs conducted with intent for embolization for acute LGIB over a 10-year period was undertaken. Pre-procedural and intra-procedural clinical variables were evaluated using uni- and multi-variate analysis. Results 123 DSAs were evaluated. Technical success was 81% (64/78) with clinical success 78%. Technical success was associated with super-selective approach, contrast extravasation on CT, haemoglobin drop, anatomical source and time from CT to DSA on univariate analysis. On multivariate analysis time from CT to DSA was significant with a higher success probability within 120 minutes with different factors being salient depending on degree of delay. Clinical success was only associated with APTT (&amp;lt;27.5s). Technical failure from a negative DSA following a positive CTMA was associated with anatomical source, haemodynamic stability, platelet count and time from CT to DSA on univariate analysis. The latter three remained so on multivariate analysis. Conclusions A triaging approach to utilising emergency DSA may be helpful. If prolonged delay between a positive CT and DSA is anticipated, with haemodynamic stability and a near normal platelet count, the DSA may not be fruitful. Technical success may be more likely if DSA occurs within 120mins. Clinical success may be more likely if APTT is within normal range.

The Value of Abdominal and Pelvic CT Scan in Trauma Patients With Low Injury Severity Score and High Glasgow Coma Scale.

Computed tomography scans became the mainstay of emergency department (ED) evaluation of trauma patients including those with a high Glasgow Coma Scale (GCS) and a low Injury Severity Score (ISS). We elected to find the value of abdominal and pelvic CT in patients with negative physical examination and Focused Assessment of Sonography for Trauma (FAST) on arrival to the ED. This study is a retrospective analysis of 901 consecutive patients from 2017 to 2019 who presented to the ED with level 2 and 3 activation criteria. Each patient received a physical examination, CT abdomen and pelvis, and FAST exam. Data were collected on external factor including GCS, ISS, age, sex, comorbidities, anticoagulation use, and surgical intervention. The patients were divided into 2 groups, Group A and B. Group A consisted of patients with a negative physical exam, FAST, and CT result. Group B included patients with a negative physical exam and FAST exam with positive CT findings. Statistical analysis was done using a Student's t-test and chi-square test for significance value of P < .05. Institutional Review Board approval was obtained for this study. A total of 901 patients were analyzed which included 489 (54.3%) male and 412 (45.7%) female with a mean age of 56.2 (SD = 22.62) years. Out of the 901 patients, 461 patients received a physical, FAST, and CT exam. Group A consisted of 442 (95.9%) patients and Group B had 19 (4.1%) patients. Both groups were similar in GCS and ISS scoring with no significance difference in age, sex, comorbidities, and anticoagulation use. There was a significant difference in the ICU and hospital mean length of stay when CT scan was positive [2 (SD = 4.23) days vs. .6 (SD = 1.33) days with P < .0001 and 4.57 (SD ± 4.17) days vs. 2.5 (SD = 2.00) days with P < .0001, respectively]. The CT findings of the 19 patients in group B consisted of 6 incidentalomas, 5 vertebral compression fractures, 4 pelvic bone fractures, 1 minor liver contusion, 1 non-specific bowel thickening, 1 non-displaced rib fracture, and 1 case of small amount of free fluid in the pelvis. None of the CT findings required surgical intervention. Computed tomography of the abdomen and pelvis in trauma patients with high GCS and low ISS with initial negative physical and FAST examination did not provide additional critical information.

18F] FDG PET/CT can improve the diagnostic accuracy for aortic endograft infection

Purpose Aortic endograft infection (EI) can result in potentially life-threatening vascular complications. Unfortunately, it is difficult to obtain a correct diagnosis at an early stage in many patients. This report aims at validating the use of [18F] FDG PET/CT imaging for suspected endograft infections in a prospectively collected cohort of patients treated with EVAR and TEVAR. Materials and methods During a 14-year period, 366 patients required aortic stent graft. All procedures were performed electively, except for one patient. Among these 366 patients, eleven patients (3%) were suspected to have aortic EI. Contrast-enhanced CT and FDG PET/CT were performed in all 11 patients. Medical charts and imaging were analysed for these 11 cases, with initial positive CT. Results The final diagnosis of EI was established in seven (1,9%) based on clinical features, laboratory investigations and a significant [18F] FDG uptake in the aortic graft as well as the aortic wall. The median time from the initial EVAR/TEVAR to diagnosed infection was 180 days. During follow-up, the seven patients had a second PET/CT that was compared with the initial evaluation, decreased uptake was correlated with clinical improvement. Conclusions Contemporary diagnostic imaging for a potentially lethal endograft infection lacks precision, this observational study illustrates the potential clinical value of [18F] FDG PET/CT in the management of aortic EI. [18F] FDG PET/CT constitutes an imaging modality able to confirm the diagnosis, monitor disease progression as well as the effect of pharmaceutical treatment and detect relapse.

P62.01 PREVALUNG: Evaluation of Lung Cancer Prevalence in Patients With Smocking-associated Atherosclerotic Cardiovascular Diseases

Lung cancer is the leading cause of cancer related death in France and Worldwide. Lung cancer screening based on low dose thoracic computed tomography (low dose CT) in patients selected on age and lifelong tobacco consumption has proven to improve lung cancer related mortality. However, the definition and identification of patients eligible for lung cancer screening is a challenge that may limit lung cancer screening program implementation. Epidemiological data shows that 30 to 40% of patients with lung cancer present a history of cardiovascular disease, mainly atheromatous diseases such as peripheral arterial diseases and coronary artery stenoses. We hypothesized that patients with history of smoking who developed atheromatous disease could represent a population at high risk to develop lung cancer. Our main objective was to evaluate the prevalence of lung cancer among patients with atherosclerotic disease and history of tobacco consumption. Our second objective was to evaluate the lung cancer screening program implemented to measure the prevalence. We implemented a monocentric prospective epidemiological study to evaluate the prevalence of lung cancer among 500 patients with inclusion criteria i.e age 45-75 years old, history of at least 10 years of daily tobacco consumption preceding the onset of an atherosclerotic disease. Principal exclusion criteria were history of active carcinoma < 5 years, symptoms of lung cancer, follow-up for lung nodules and grade IV dyspnea. Patients with inclusion criteria are referred for an inclusion visit (V0) with a thoracic surgeon by adult cardiologists, vascular surgeons and adult cardiac surgeons in charge of the patient. After information and inclusion, a low dose CT scan is scheduled within 7 months and a smoking cessation visit is proposed in case of active smoking. Blood and gut microbiota samples are harvested the day of the low dose CT. Positive low-dose CT are discussed weekly at the multidisciplinary thoracic oncologic staff meeting and managed accordingly to the current European and national recommendations. A clinical follow-up is scheduled by phone at 3, 6 and 12 months after the low-dose CT to evaluate oncologic and cardiovascular events. Between November 2019 and April 2021 we included 487 of the 500 patients scheduled, 330 low dose CT were completed, 7 localized primary lung cancer were resected by minimally invasive lobectomy, 1 patient was treated by radiation alone without pathological proof for a lung nodule, 1 patient was related with systemic therapy for a stage IV primary lung cancer and 2 patients are waiting for surgical resection for clinically localized lung cancers. The implementation of a lung cancer screening program dedicated to patients followed-up for tobacco related atherosclerotic diseases is feasible and will allow to evaluate both lung cancer prevalence and short-term benefits of lung cancer screening in this population.

CT IMAGING FEATURES OF PATIENTS WITH COVID-19 AT A TERTIARY CARE HOSPITAL: EXPERIENCE FROM PAKISTAN

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: CT Chest is considered as one of the important modalities for the diagnosis and assessment of progression of COVID-19 disease. We conducted a study highlighting salient features of CT chest in patients with COVID-19 in a tertiary care center in Karachi, Pakistan. METHODS: This was a cross-sectional study done at Aga khan university from April 2020 to December 2020. Adult patients who had a positive COVID-19 PCR and underwent CT scan chest were included in the study. Five hundred and eighteen patients who underwent CT scan chest were selected for screening. One hundred and twelve patients who were positive for COVID-19 PCR were selected for review. Two patients were later excluded as they had chronic changes on CT scan due to underlying comorbidities. RESULTS: Among the study cohort of 110 patients, 70 (63.7 %) were males and 40 (36.4 %) were females with a mean age of 56.5 ± 14.8 years (range 46-67 years). Out of 110 patients, 79 underwent high-resolution CT (HRCT) scan and 31 underwent contrast-enhanced CT chest. The most common abnormality seen on CT was ground-glass opacities (79%), followed by consolidation (62%), crazy paving pattern (32%), vascular enlargement sign (27%) and fibrotic-like features or reticulations (21%). Furthermore, air bronchogram sign was seen in 21%, pleural effusion was seen in 8% and lymphadenopathy in 7% of patients. CONCLUSIONS: CT scan chest is a key tool of investigation in the diagnosis of COVID-19 disease. Studies from across the world have identified specific CT scan patterns that can aid in the diagnosis of the disease. This is a study from a low to middle-income country that describes the spectrum of radiological features found in COVID-19 and has also focused on certain atypical features associated with COVID-19. CLINICAL IMPLICATIONS: Certain radiological features like ground-glass opacities and consolidation are a known features of COVID-19. This study emphasizes on the most frequent radiological features of COVID seen in a tertiary care hospital in Pakistan. Chest CT imaging has a high negative predictive value and high sensitivity for diagnosing COVID-19 and can be considered as an alternative primary screening tool for COVID-19 in epidemic areas. Moreover, a negative RT-PCR test and a positive CT chest finding can suggest COVID-19. Hence as a clinician and radiologist, one should be aware of all the spectrum of radiological features so that early diagnosis and management can be facilitated. DISCLOSURES: No relevant relationships by Safia Awan, source=Web Response No relevant relationships by Kulsoom Fatima, source=Web Response no disclosure on file for Basit Salam;No relevant relationships by Aqusa Zahid, source=Web Response No relevant relationships by Syed Muhammad Zubair, source=Web Response No relevant relationships by Ali Zubairi, source=Web Response

S668 Clinical Predictors of a Positive CT Angiogram Study Used for the Evaluation of Acute Gastrointestinal Hemorrhage

Introduction: Acute gastrointestinal (GI) bleeding is one of the leading causes of emergency department visits and hospital admissions. CT angiography (CTA) has had an expanding role in the evaluation of acute GI bleeding because it is rapidly performed, widely available, reasonably sensitive and provides precise localization when positive. We attempted to identify patient and clinical characteristics that predict CTA results in order to help guide the utilization of this modality in patients with acute GI bleeding. Methods: In this retrospective study, we analyzed all CTAs performed for the evaluation of GI bleeding in the Duke University healthcare system between October 2019 and March 2020. We captured patient characteristics including age, sex, vital signs, hemoglobin, platelets, PT/INR and anticoagulation status. We grouped study indication into three categories: upper GI bleeding (hematemesis or coffee ground emesis); small bowel bleeding (melena or dark stool); and lower GI bleeding (hematochezia or bright red blood per rectum) as indicated by the ordering provider. Chi-square, Wilcoxon, t-test, and multivariate logistic regression were used to describe and assess the relationship between patient characteristics and study outcomes (Table 1). Results: A total of 317 studies were performed between October 2019 and March 2020. Forty-three patients (13.6%) had a CTA positive for active bleeding. Multivariable logistic regression showed that after controlling for age, MAP and indication, only a hemoglobin drop from baseline was significantly associated with a positive CTA. For each 1 unit increase in hemoglobin drop, the odds of a positive CT increased by 1.17 (OR 1.17 95% CI 1.00 – 1.36, p = 0.04). Age (OR 1.02 95% CI 0.99 – 1.04, p = 0.06) and lower GI bleeding (OR 2.09 95% CI 0.94 - 4.64, p = 0.07) approached statistical significance. Conclusion: In patients who present to the hospital with GI bleeding, those with a drop in hemoglobin from baseline are most likely to have active bleeding found on CTA. Older age and suspected lower GI bleeding are also likely to be valuable predictors of a positive CTA. In the absence of these factors, CTA is less likely to be clinically useful.Table 1.: Mortality in post-bariatric surgery patients that had UGIB (OR).

Exposure to sulfur mustard increases the risk for mortality in patients with COVID-19 infection: A cohort study.

ObjectiveThis study aims to assess the prognosis of inpatients with COVID-19 infection who have a history of sulfur mustard exposure.MethodsWe started a cohort study in October 2020 and ended in May 2021 on inpatients with COVID-19 infection who had been admitted to university healthcare centers. The analytic sample included 960 inpatients having COVID-19 infection (192 with; and 768 without sulfur mustard exposure). The exposed patients were male war veterans, and the unexposed patients were male individually age-matched people. All patients had a positive RT-PCR test and a positive chest CT for COVID-19. The outcome was death within 28 days of admission, and the predictors were clinical features recorded at patients' bedsides.ResultsThere was a significantly higher prevalence for asthma (p = 0.026) and pulmonary disease other than asthma (p < 0.001) in patients with the exposure. Sulfur mustard exposure was associated with increased risk for mortality of COVID-19 [hazard ratio (95% CI) = 1.92 (1.14,3.24), p = 0.013]. Early intubation signified a poor prognosis [hazard = 7.34 (4.65,11.58), p < 0.001]. However, individuals with higher PaO2 [hazard = 0.97 (0.95,0.98), p < 0.001], or people undergoing O2 therapy early upon admission [hazard = 0.58 (0.38,0.89), p = 0.011] showed lower risks for mortality. Individuals with asthma were at higher risk for mortality [hazard = 3.76 (1.69,8.36), p = 0.001].ConclusionIndividuals with COVID-19 infection and sulfur mustard exposure should be considered high-risk patients and that, healthcare settings should be ready to provide critical care for them, including O2 therapy. They are more likely to have asthma or other pulmonary diseases.

The effects of Alzheimer's and Parkinson's disease on 28-day mortality of COVID-19

We compared the prognosis of inpatients with a known diagnosis of Alzheimer's or Parkinson's disease who have COVID-19 infection with other hospitalized patients with COVID-19. Our cohort study started in October 2020 and ended in May 2021 and included inpatients with COVID-19 infection who were admitted to hospitals. From a total of 67,871 patients with a confirmed diagnosis of COVID-19, a sample of 3732 individuals were selected of which 363 had Alzheimer's, and 259 had Parkinson's disease. All patients had both positive RT-PCR test and positive chest CT for COVID-19. The outcome was dead within 28 days of admission and the predictors were a large number of demographic and clinical features, and comorbidities recorded at patients’ bedside. Mortality were 37.5%, 35.1%, and 29.5% in patients with Alzheimer's disease, Parkinson's disease; and in other patients, respectively. The hazard ratio for Alzheimer's disease was 1.27 (95% CI, 1.06–1.53, p=0.010) and for Parkinson's disease was 1.17 (95% CI, 0.94–1.46, p=0.171). Age was a predictor of mortality, hazard ratio=1.04 (95% CI, 1.03–1.05, p<0.001). Patients with Alzheimer's disease and COVID-19 infection were older and more likely to have a loss of consciousness on admission (both p≤0.001). We concluded that inpatients with Alzheimer's disease have an increased risk for 28-day mortality from COVID-19 and healthcare settings should be ready to provide critical care for them such as early intubation and immediate O2 therapy. However, Parkinson's disease does not significantly predict higher mortality of COVID-19.

A case report of rhino-facial mucormycosis in a non-diabetic patient with COVID-19: a systematic review of literature and current update

BackgroundCOVID-19 disease may be associated with a wide range of bacterial and fungal infections. We report a patient with COVID-19 infection who developed rhino-facial mucormycosis during treatment with corticosteroids.Case presentationA 59-year-old non-diabetic male patient was admitted with a diagnosis of COVID-19 based on positive RT-PCR and CT of the lungs. Due to sever lung involvement, he was treated with methylprednisolone. The patient was re-admitted to hospital, due to nasal obstruction and left side facial and orbital swelling, several days after discharge. In sinus endoscopic surgery, debridement was performed and the specimens were sent to pathology and mycology laboratories. A nasal biopsy showed wide hyphae without septa. The sequenced PCR product revealed Rhizopus oryzae. Despite all medical and surgical treatment, the patient died. In addition, the characteristics of patients with COVID-19-associated mucormycosis were reviewed in 44 available literatures. In most studies, diabetes mellitus was the most common predisposing factor for mucormycosis.ConclusionOur report highlights the need for assessing the presence of mucormycosis in patients with COVID-19 and also it shows that physicians should consider the potential for secondary invasive fungal infections in COVID-19 cases.

Assessment of Clinical Characteristics and Chest CT Findings of COVID-19 Prediagnosed Patients Admitted to the Emergency Department: A Retrospective Study

Introduction: This study aimed to define the clinical features and laboratory findings that may be associated with COVID-19 pneumonia in patients with suspected COVID-19 pneumonia who presented to the emergency department in order to be able to recognize the disease early until molecular tests are available, and thus to isolate sick people as soon as possible. Patients and Methods: We retrospectively examined patients who were evaluated with the suspicion of COVID-19 between March 2020 and August 2020. We used the patient information management system to record patient demographic and clinical features, laboratory findings, and CT results. In subgroups with and without pneumonia, we compared these characteristics in confirmed COVID-19 patients. Results: Our study included 1,277 patients who were evaluated for suspected COVID-19. COVID-19 pneumonia was detected in 71.2% (n=210) of a total of 295 (23.4%) patients with a diagnosis of COVID-19 who were confirmed by RT-PCR positivity. Although 56.2% (n=18) of those with pneumonia were men, no statistically significant relationship was detected between gender distribution and CT findings (p=0.449). When we compared the patients in 3 subgroups according to age groups, it was observed that 59.4% (n=38) of those with negative CT findings were in the 18-44 age group, and 44.8% (n=94) of those with positive CT findings were 65 and over age group, and this distribution was found to be statistically significant (p&lt;0.001). Pneumonia was detected in 58.3% (n=49) of COVID-19 cases (n=84) with a suspected exposure history (p=0.008). The most common symptoms in patients with positive CT findings (n=210) were fever (40.5% n=85) and fatigue (40.5% n=85), cough (32.9% n=69), and shortness of breath (28.6% n=60). The most common comorbidity in cases diagnosed with COVID-19 was HT (33.9%; n=100/295), followed by AF (19.3%; n=57/295), and the rates of HT and AF in those with COVID-19 pneumonia were statistically significantly higher compared to the CT-negative group (p&lt;0.001 and p=0.002, respectively).COVID-19 pneumonia was more common in hospitalized patients (n=124), and hospitalization lengths were longer in both emergency and ICU admissions (p&lt;0.001 and p=0.008). In our analysis in terms of the survival relationship, it was observed that 87.5% (n=35) of the COVID-19 cases who died had pneumonia (p&lt;0.042). Low saturation and high respiratory rate per minute at the time of admission were associated with COVID-19 pneumonia (p&lt;0.001). In the group with COVID-19 pneumonia, haemoglobin, GFR, and pCO2 values were recorded lower at the time of admission compared to patients with negative CT (p&lt;0.001, p&lt;0.001, p&lt;0.05, respectively), while leukocytes, neutrophils, CRP, D-dimer, LDH, hs-troponin, AST and bilirubin were recorded as higher (p&lt;0.05, p&lt;0.01, p&lt;0.001, p&lt;0.001, p&lt;0.001, p&lt;0.001, p=0.01, p=0.01, respectively). Conclusion: Identifying patient features linked with COVID-19 pneumonia at the time of admission may influence our decision to have CT scans in emergency departments, regardless of the RT-PCR result, and may result in early disease identification and treatment.

Is CT thorax, abdomen and pelvis a useful test in patients with weight loss?

Unintentional weight loss is an important clinical problem. The role of CT is not firmly established in the workup of these patients. The aim of this study is to determine the diagnostic yield of CT Thorax, Abdomen and Pelvis (CT TAP) in patients with unexplained weight loss and to determine whether clinical or laboratory variables are associated with positive CT findings. A retrospective review was performed of CT TAP examinations over 12 months with weight loss as an indication. Patients' electronic records and radiology reports were reviewed. Clinical and laboratory variables were assessed for correlation with positive findings on CT. 461 CT TAP studies with weight loss as the primary indication were identified. 124 were excluded; 82 due to a recent history of malignancy, 41 because CT TAP was used for staging of a new malignancy and one study was incomplete. This left 337 eligible examinations. 217 studies had findings of no clinical relevance, 50 studies were normal, 40 studies identified a possible cause of weight loss and 30 studies identified a definite cause. Of the 40 where a possible cause was identified, further work up led to a diagnosis which explained the weight loss in 13 patients. The diagnostic yield of CT TAP was 12.8%. Age, abdominal symptoms, degree of weight loss, anaemia, tumour markers and LDH did not significantly correlate with positive findings on CT. CT TAP is a helpful investigation in patients with unexplained weight loss with a diagnostic yield of 12.8%.

Swab and Sputum SARS-CoV-2 RNA-Negative, CT-Positive, Symptomatic Contacts of COVID-19 Cases: A Hypothesis-Generating Prospective Population-Based Cohort Study of Eight Clusters.

Background: While some contacts of COVID-19 cases become symptomatic and radiographically abnormal, their SARS-CoV-2 RNA tests remain negative throughout the disease course. This prospective population-based cohort study aimed to explore their characteristics and significances.Methods: From January 22, 2020, when the first COVID-19 case was identified in Hefei, China, until July 3, a total of 14,839 people in Feidong, Hefei, with a population of ~1,081,000 underwent SARS-CoV-2 RNA testing, where 36 cases (0.2%) with confirmed COVID-19 infection (Group 1) and 27 close contacts (0.2%) testing negative for SARS-CoV-2 RNA but having both positive COVID-19 exposure histories and CT findings (Group 2) from eight clusters were prospectively identified. Another 62 non-COVID-19 pneumonia cases without any exposure history (Group 3) were enrolled, and characteristics of the three groups were described and compared. We further described a cluster with an unusual transmission pattern.Results: Fever was more common in Group 2 than Groups 1 and 3. Frequency of diarrhea in Group 1 was higher than in Groups 2 and 3. Median leucocyte, neutrophil, monocyte, and eosinophil counts were all lower in Groups 1 and 2 than in Group 3. Median D-dimer level was lower in Group 1 than in Groups 2 and 3. Total protein and albumin levels were higher in Groups 1 and 2 than in Group 3. C-reactive protein level was lower and erythrocyte sedimentation rate slower in Groups 1 and 2 than in Group 3. Combination antibacterial therapy and levofloxacin were more often used in Group 3 than in Groups 1 and 2. Lopinavir/ritonavir was more often administered in Groups 1 and 2 than in Group 3. Group 1 received more often corticosteroids than Groups 2 and 3. Group 2 received less often oxygen therapy than Groups 1 and 3. Median duration from illness onset to discharge was longer in Group 1 (27 d) than Groups 2 and 3 (both 17 d). Among contacts of a confirmed COVID-19 patient, only one had a positive virus RNA test but remained asymptomatic and had negative CT findings, and three had negative virus RNA tests but had symptoms and positive CT findings, one of whom transmitted COVID-19 to another asymptomatic laboratory-confirmed patient who had no other exposures.Conclusions: Among close contacts of confirmed COVID-19 cases, some present with positive symptoms and CT findings but test negative for SARS-CoV-2 RNA using common respiratory (throat swab and sputum) specimens; they have features more similar to confirmed COVID-19 cases than non-COVID-19 pneumonia cases and might have transmitted SARS-CoV-2 to others. Such cases might add to the complexity and difficulty of COVID-19 control. Our hypothesis-generating study might suggest that SARS-CoV-2 RNA testing by rRT-PCR assays of common respiratory (throat swab and sputum) specimens alone, the widely accepted “golden standard” for diagnosing COVID-19, might be sometimes insufficient, and that further studies with some further procedures (e.g., testing via bronchoalveolar lavage or specific antibodies) would be warranted for Group 2-like patients, namely, the SARS-CoV-2 RNA-negative (tested using common respiratory specimens), radiographically positive, symptomatic contacts of COVID-19 cases, to further reveal their nature.

FDG PET/CT imaging features and clinical utility in COVID-19

PurposeTo determine the imaging findings and potential clinical utility of FDG PET/CT in patients with laboratory-confirmed COVID-19. MethodsWe performed a single institution retrospective review of patients diagnosed with COVID-19 using real time reverse transcription–polymerase chain reaction (RT-PCR) who underwent FDG PET/CT for routine cancer care between March 1, 2020 to April 30, 2020, during the height of the pandemic in New York City, New York, United States. PET/CT scans were retrospectively reviewed for imaging findings suspicious for COVID-19. For positive scans, PET and CT findings were recorded, including location, FDG avidity (SUVmax) and CT morphology. Patient demographics and COVID-19 specific clinical data were collected and analyzed with respect to PET/CT scan positivity, lung SUVmax, and time interval between PET/CT and RT-PCR. ResultsThirty-one patients (21 males and 10 females, mean age 57 years ± 16) were evaluated. Thirteen of 31 patients had positive PET/CT scans, yielding a detection rate of 41.9%. Patients with positive scans had significantly higher rates of symptomatic COVID-19 infection (77% vs 28%, p = 0.01) and hospitalizations (46% vs. 0%, p = 0.002) compared to patients with negative scans. Eleven of 13 patients (84.6%) with positive scans had FDG-avid lung findings, with mean lung SUVmax of 5.36. Six of 13 patients (46.2%) had extrapulmonary findings of FDG-avid thoracic lymph nodes. The detection rate was significantly lower when the scan was performed before RT-PCR versus after RT-PCR (18.8% (n = 3/16) vs. 66.7% (n = 10/15), p = 0.009). Lung SUVmax was not associated with COVID-19 symptoms, severity, or disease course. ConclusionFDG PET/CT has limited sensitivity for detecting COVID-19 infection. However, a positive PET scan is associated with higher risk of symptomatic infection and hospitalizations, which may be helpful in predicting disease severity.

P–097 The impact of SARS-CoV–2 on male gonadal function. A longitudinal study

Study questionCan severe acute respiratory syndrome coronavirus 2 (SARS-CoV–2) be detected in the semen of SARS-CoV–2 positive men, and does SARS-CoV–2 infection affect male reproductive function?Summary answerNo SARS-CoV–2 RNA was detected in semen. An impact of SARS-CoV–2 infection on semen quality and reproductive hormone profile awaits evaluation at 3 + 6 months follow-up.What is known alreadySARS-CoV–2 may use angiotensin-converting enzyme (ACE)2 as an entry point into the cell. As ACE2 is expressed in testicular tissue, it has been speculated that SARS-CoV–2 may affect the male reproductive system. A cohort study including 38 male COVID–19 patients showed that SARS-CoV–2 was present in the semen of six patients (15.8%) [Li et al., 2020]. Later studies including a total of 223 patients have not provided evidence of transmission of SARS-CoV–2 via semen. There are to date no available longitudinal studies on semen quality following SARS-CoV–2 infection.Study design, size, durationLongitudinal cohort study including 50 non-hospitalized men from the general population in the Capital Region of Denmark. All participants had a confirmed SARS-CoV–2 infection by reverse-transcription polymerase chain reaction (RT-PCR) on oropharyngeal swab material within the last week. The presence of SARS-CoV–2 in semen samples by RT-PCR, semen parameters and reproductive hormone profile were assessed at inclusion and at 3 + 6 months follow-up. SARS-CoV–2 antibody levels were assessed 3–5 weeks after inclusion.Participants/materials, setting, methodsSARS-CoV–2-positive males (age 18–60 years) were included. Oropharyngeal and semen samples were tested by RT-PCR applying the E-Sarbeco primers and probe published by Corman et al. 2020 and adapted to TaqMan Fast Virus 1-step master mix and LightCycler 480 as previously reported by Jørgensen et al. 2020. SARS-CoV–2 antibodies were detected using the serological immunoassay from Shenzhen YHLO Biotech on the iFlash 1800. Semen quality parameters were analysed according to World Health Organisation (WHO) standards.Main results and the role of chanceTo date, 25 men with a mean age of 35 years have been included in the study. SARS-CoV–2 RNA could not be detected in the semen samples of any of the 25 men at the time of inclusion. Twenty-one of the 25 men (84,0%) had a same day RT-PCR-confirmed SARS-CoV–2 infection in an oropharyngeal swab. RT-PCR cycle threshold (ct) values were distributed as follows: four (19,0%) were strongly positive (ct < 25), 16 (76,2%) intermediately positive (ct 25–35) and one (4,8%) weakly positive (ct 35–45). The four men without PCR-confirmed SARS-CoV–2 infection all had a positive IgG response to SARS-CoV–2 at the time of inclusion. Longitudinal semen and reproductive hormone profiles analyses will be performed. Further studies are needed to prove whether SARS-CoV–2 can be transmitted to the male reproductive tract and whether SARS-CoV–2 infection may cause alterations of spermatogenesis and endocrine function.Limitations, reasons for cautionStrengths of this study are the unselected population of men examined within a week after confirmed SARS-CoV–2 infection and the follow-up of semen parameters and endocrine profile. Limitations are the limited sample size and the fact that semen quality was not known before the participants were diagnosed with COVID–19.Wider implications of the findings: Knowledge of viral detection and semen persistence of SARS-CoV–2 is essential for clinical practice and public health. There is a need for evidence-based counselling on the impact of SARS-CoV–2 infection for patients undergoing assisted reproduction technology and patients who have a need for semen cryopreservation.Trial registration numberH–20027362

A Prognostic Model for Predicting One-Month Outcomes among Emergency Department Patients with Mild Traumatic Brain Injury and a Presenting Glasgow Coma Scale of Fifteen.

The lack of well-performing prognostic models for early prognostication of outcomes remains a major barrier to improving the clinical care of patients with mild traumatic brain injury (mTBI). We aimed to derive a prognostic model for predicting incomplete recovery at 1-month in emergency department (ED) patients with mTBI and a presenting Glasgow Coma Scale (GCS) score of 15 who were enrolled in the HeadSMART (Head Injury Serum Markers for Assessing Response to Trauma) study. The derivation cohort included 355 participants with complete baseline (day-of-injury) and follow-up data. The primary outcome measure was the Glasgow Outcome Scale Extended (GOSE) at 1-month and incomplete recovery was defined as a GOSE <8. At 1-month post-injury, incomplete recovery was present in 58% (n = 205) of participants. The final multi-variable logistic regression model included six variables: age in years (odds ratio [OR] = 0.98; 95% confidence interval [CI]: 0.97-1.00), positive head CT (OR = 4.42; 95% CI: 2.21-9.33), history of depression (OR = 2.59; 95% CI: 1.47-4.69), and self-report of moderate or severe headache (OR = 2.49; 95% CI: 1.49-4.18), difficulty concentrating (OR = 3.17; 95% CI: 1.53-7.04), and photophobia (OR = 4.17; 95% CI: 2.08-8.92) on the day-of-injury. The model was validated internally using bootstrap resampling (1000 resamples), which revealed a mean over-optimism value of 0.01 and an optimism-corrected area under the curve (AUC) of 0.79 (95% CI: 0.75-0.85). A prognostic model for predicting incomplete recovery among ED patients with mTBI and a presenting GCS of 15 using easily obtainable clinical and demographic variables has acceptable discriminative accuracy. External validation of this model is warranted.

Determination of Duration of the Intensive Phase of Chemotherapy for Respiratory Tuberculosis in Children without Bacterial Excretion and at No Risk of Multiple and Extensive Drug Resistance

The objective of the study: to develop criteria to evaluate the duration of the intensive phase of chemotherapy for respiratory tuberculosis in children without bacterial excretion and at no risk of multiple and extensive drug resistance of tuberculous mycobacteria.Subjects and methods. Totally, 93 patients with newly diagnosed respiratory tuberculosis without bacterial excretion and at no risk of multiple and extensive drug resistance of tuberculous mycobacteria. Their age varied from 2 to 12 years old. Regimen III was used: the intensive phase – 4 drugs (isoniazid, rifampicin, pyrazinamide, ethambutol – HRZE).Results. The intensive phase lasted for 2 months in 39.8% of cases – the main criteria were achieved (relief of intoxication symptoms, normal blood rates, positive or stable CT changes) after 2 months and there was no indication to extend the duration of it. The intensive phase lasted for 3 months in 37.6% of cases – the main criteria were achieved after 2 months and there was at least one additional indication to extend it (17.2%); and the main criteria were achieved after 3 months and there was no indication to extend the duration of it (20.4%). The intensive phase lasted for more than 3 months (4 to 6 months) in 22.6% of cases – the main criteria were achieved after 3 months and there was at least one additional indication to extend it (12.9%), as well as in the case of failure to achieve the main criteria after 3 months regardless of the presence/absence of additional indications to extend its duration (9.7%).Conclusion. Various combinations of the main criteria and additional indications made the basis for differential approach to determining the duration of the intensive phase of chemotherapy in children with respiratory tuberculosis

Chinese medical students\u2019 disposition for critical thinking: a mixed methods exploration

BackgroundCritical thinking (CT) is an essential competency for medical students. This study’s aim was to evaluate Chinese medical students’ disposition for CT and to explore the impact of current trends in medical education on students’ CT development.MethodsWe used multistage stratified cluster sampling to recruit a total of 1241 medical students among five different years of training and from three medical institutions in China. The Critical Thinking Disposition Inventory-Chinese Version (CTDI-CV) and self-reported information were used to collect cross-sectional data. Based on the data from the CTDI-CV, 112 medical students in clinical course training from a single institution continued one-year follow-up. Their one-year CTDI-CV score changes were collected regarding various medical education variables.ResultsThe mean CTDI-CV score of the 1241 medical students was 287.04 with 729 (58.7%) students receiving a score of 280 or higher. There were statistically significant differences in schools attended(F = 3.84, P < 0.05), year of school attended(F = 10.32, P < 0.001), GPA(F = 6.32, P < 0.01), weekly time spent learning after class(F = 14.14, P < 0.001), attitude toward medicine(F = 28.93, P < 0.001), desire to be a doctor after graduation(t = − 3.35, P < 0.001), familiarity with CT(F = 20.40, P < 0.001), and perception of importance of CT(F = 22.25, P < 0.001). The participants scored the highest on the CTDI-CV subscales of “inquisitiveness” and the lowest on “truth seeking.” The 112 students in the longitudinal study had significantly lower total CT scores after one academic year follow-up.ConclusionsChinese medical students generally exhibited positive CT dispositions. The cross-sectional survey and one-year longitudinal study indicated that students’ CT disposition diminished as they progressed through traditional medical training. Our study contributes to understanding the status of Chinese medical education of and influential factors on medical students’ CT disposition.

ROLE OF COMPUTED TOMOGRAPHY SCAN IN POST-COVID SINO-NASAL MUCORMYCOSIS WITH CLINICO-EPIDEMIOLOGICAL CORELATION

Ÿ OBJECTIVE: Ÿ To evaluate the spectrum of radiological ndings in post-COVID sinonasal mucormycosis cases Ÿ To evaluate the demography, comorbidities and treatment modalities used in these patients which may be attributable to development of sinonasal mucormycosis after recovery from COVID-19 disease. Ÿ MATERIALS AND METHODS: In this retrospective study, 80 out of 793 patients who came for follow-up after recovering from COVID pneumonia, had symptoms related to paranasal sinus and orbit. CECT PNS and orbit was performed in them and 69 patients had positive CT ndings. Clinico-epidemiological data was recorded. The correlation between CT ndings and clinical history was performed by Chi2 test. P value &lt;0.05 was considered as statistically signicant. Ÿ RESULTS: Majority - 48 (69.5%) belonged to age group between 40-60 years. Diabetes mellitus was the most common comorbid condition seen in 58 (84%) patients. The treatment history during COVID-19 disease revealed administration of intravenous or oral steroids in 54 (78.2%) patients, Injection Remdesivir in 48 (69.5%), broad-spectrum antibiotics in 36 (52.2%). 15 (21.7%) were given non-invasive ventilation and 7 (10.1%) needed invasive ventilation. Ethmoidal sinus- 68 cases (98.5%) and maxillary sinus- 65 cases (94.2%) were most frequently affected sinus. Intraorbital extension of the soft tissue was seen in 37 (53.6%) and intracranial extension was seen in 11 (15.9%) cases. On follow-up, fungal hyphae were detected in 39 (56.5%) cases via KOH mount or biopsy. Ÿ CONCLUSION: The widespread use of steroids/monoclonal antibodies/broad-spectrum antibiotics/oxygen therapy for treating COVID-19 may lead to the development/exacerbation of pre-existing fungal diseases. Health care professionals should act promptly when there is a suspicion of mucormycosis